What Vivitrol is
Vivitrol is extended-release naltrexone, given as an injection into the muscle once every 28 days. Naltrexone is an opioid antagonist: it sits on the opioid receptors and blocks them. If you take an opioid while Vivitrol is active, it does not produce a high, and for many people knowing that removes the pull. For alcohol, the same blockade dampens the reward drinking gives, and most patients report fewer and weaker cravings.
It is approved for two uses: preventing relapse to opioids after you have stopped, and treating alcohol dependence. It is not a controlled substance, it does not cause dependence, and there is nothing to take home. Compared with daily oral naltrexone, the injection removes the problem of skipping a dose on a hard day.
Who it is for, and who needs to wait
Vivitrol suits people who have already stopped using and want protection against going back, people who do not want to be on a daily buprenorphine product, and people with alcohol dependence who want a monthly option. Some patients move to Vivitrol after tapering off buprenorphine.
The critical requirement is this: you must be completely opioid-free for 7 to 14 days before the first dose. That includes pain medication, methadone and buprenorphine, which needs the longer end of that window. Given while any opioid is still in your system, Vivitrol causes sudden, severe withdrawal that can put you in the hospital. Before the first injection, Dr. Escarria confirms this through your history, a urine drug screen and, when there is any doubt, a naloxone challenge: a small dose of naloxone given in the office to make sure no withdrawal follows. This is not a step we skip.
The injection
The injection goes into the gluteal muscle, alternating sides each month, and takes a few minutes. The medication releases slowly over the following four weeks. Before starting, and periodically afterward, we check liver tests, because naltrexone is processed by the liver and is not used when liver disease is severe. Your next dose is booked before you leave, every 28 days, because the blockade fades if the interval stretches.
Does insurance cover it? Vivitrol is covered by Medicare, Medicaid and Aetna, Blue Cross Blue Shield, Cigna and other in-network plans, but prior authorization is required by virtually every plan, and most re-verify it monthly. Our front desk submits the request before your first dose and manages the monthly renewals. The clinic orders your dose from the specialty pharmacy only after approval comes through, so the timing of the first injection depends on the insurer. Patients with commercial insurance may qualify for the manufacturer copay program, which we help you enroll in; it does not apply to Medicare or Medicaid. Read more about insurance and self-pay.
What to expect
- Consultation with Dr. Escarria: history, exam, labs including liver tests, urine screen, and a plan for the opioid-free period if you are not there yet.
- Prior authorization submitted by our office. You are called when it is approved and the dose is ordered.
- First injection after your opioid-free period is confirmed, at either clinic. You may be asked to stay briefly afterward.
- Monthly visits for the injection, a check-in on cravings and mood, and counseling coordination. Liver tests are repeated periodically.
Side effects and an important safety point
The most common side effects are soreness, redness or a firm lump at the injection site for a few days, nausea in the first week, headache, tiredness and trouble sleeping. Rarely the injection site reaction is more serious and needs to be seen. Tell us if you have liver disease, are pregnant or plan to have surgery, since Vivitrol blocks opioid pain medication and the surgical team needs to know.
The safety point every Vivitrol patient must understand: your tolerance to opioids drops while you are on it. If you stop Vivitrol, or try to override the block with a large dose, the amount of opioid that once felt normal can now cause an overdose. Keep naloxone at home, and if you decide to stop treatment, do it with the doctor rather than by missing an appointment.
Can I go straight from Suboxone to Vivitrol?
Not directly. Buprenorphine stays on the receptors for a long time, so you need to taper off and then stay opioid-free for 10 to 14 days before the first Vivitrol dose. Dr. Escarria plans the taper and the gap with you, and confirms with a urine screen and, if needed, a naloxone challenge before injecting.
Does Vivitrol help with drinking?
Yes. It is approved for alcohol dependence and reduces both craving and the reward from drinking. You do not need to be fully abstinent from alcohol to start, though the opioid-free rule still applies to everyone, including patients being treated for alcohol only.
How long do people stay on Vivitrol?
Most stay on it for six to twelve months, and some longer. There is no fixed limit. The decision to stop is made with the doctor, with a plan for the drop in opioid tolerance that follows.
Which clinic gives Vivitrol?
Both. Injections are given at Davie for Broward County and at Boynton Beach for Palm Beach County. Your dose is ordered to the clinic you attend once authorization is approved.
What does Vivitrol cost with insurance?
That depends on your plan, and we do not quote figures. With prior authorization approved, Medicare, Medicaid and Aetna, Blue Cross Blue Shield, Cigna and other in-network plans cover the injection with your usual copay or coinsurance. Commercial patients may qualify for the manufacturer copay program, which we help you enroll in.